Diagnostic value of tonsillectomy in positron emission tomography and computerised tomography negative carcinoma of unknown primary

Authors

  • Meenu Induchoodan Department of ENT, Government Medical College, Kottayam, Kerala, India
  • Rajeev Kumar Madhavan Department of ENT, Government Medical College, Kottayam, Kerala, India
  • Shibu George Department of ENT, Government Medical College, Kottayam, Kerala, India http://orcid.org/0000-0003-3309-8019

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20213904

Keywords:

Carcinoma of unknown primary, Head and neck, PET-CT, Tonsillectomy

Abstract

Carcinoma of unknown primary (CUP) represents a heterogeneous group of malignancy metastasis unique biology of which remains poorly understood. Even after a complete diagnostic workup including positron emission tomography and computerised tomography (PET-CT) scans the primary site of origin may remain unclear. This case series analysed the diagnostic value of bilateral palatine tonsillectomy in evaluating PET-CT negative head and neck squamous cell CUP. From retrospective analysis of cluster of 68 cases with metastatic cervical nodes with no obvious primary referred for ENT evaluation during a period of 20 months, we identified 5 cases where pan endoscopy and radiological evaluation including PET-CT were negative in detecting the primary. All 5 patients underwent bilateral palatine tonsillectomy along with biopsies from base of tongue and nasopharynx as a part of completion of diagnostic work-up. Tonsillar squamous cell carcinoma was revealed by subsequent histopathology examination in 4 out of 5 patients despite negative PET-CT evaluation. Blind biopsies from other sites like nasopharynx and base of tongue were unfruitful. Our experience strongly emphasises the fact that bilateral palatine tonsillectomy has a high yield in detecting primary even in PET negative CUP, though it needs a larger evidence base.

Author Biographies

Meenu Induchoodan, Department of ENT, Government Medical College, Kottayam, Kerala, India

senior resident

department of ENT

Rajeev Kumar Madhavan, Department of ENT, Government Medical College, Kottayam, Kerala, India

associate professor

department of ENT

Shibu George, Department of ENT, Government Medical College, Kottayam, Kerala, India

professor & HOD

department of ENT

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Published

2021-09-27

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Case Series